Print this Page Cushing's Message Boards

Urine Testing

Midnight Salivary Cortisol Versus Urinary Free and Midnight Serum Cortisol as Screening Tests for Cushing's Syndrome


Urine Tests: These involve collecting urine, usually for periods of twenty-four hours at a time.

bullet

Twenty-four Hour Urine:

The doctor will give you a gallon collection jug, usually with boric acid in it. The instructions are usually printed on the side. Generally, you urinate first thing in the morning, as usual. after that, you collect the rest of the urine for the next 24 hours in the jug. The directions usually tell you to refrigerate the jug.

bullet

Directions for the Twenty-four Hour Urine Test

Physicians have always relied upon analysis of urine specimens in order to diagnosis and treat many disease processes. Twenty-four hour urine collections are often employed to estimate the production rates of various hormones. The accuracy of test results depends entirely on the accuracy of the urine collection technique. These instructions are provided as a guide to ensure that your 24-hour urine collection is obtained in a manner that will permit reliance upon the test results.

Urine samples should be collected in a large cup, urine collection hat or other container and then poured into the large bottle. Do not try to urinate directly into the bottle. Void urine prior to bowel movements in order to avoid losing urine that might normally be passed during a bowel movement. Urine collection hats can usually be purchased at medical supply stores if not provided by your physician or lab. If you should have a bowel movement while urinating the urine collection hat should keep the urine clean if used correctly.

Urine samples should be collected in a large cup or other container and then poured into the large bottle. Do not try to urinate directly into the bottle. Void urine prior to bowel movements in order to avoid losing urine that might normally be passed during a bowel movement.

Some patients are asked to collect more than one consecutive 24-hour urine sample. If that is the case, you should complete the first collection as instructed. Then, begin the second collection by adding any urine made in the next 24-hours to the second bottle. You should not discard any urine when starting the second or any subsequent collections. Simply change bottles at the stop and start times after adding that last sample required to complete the previous collection.

The bottles for some tests contain a weak acid as a preservative. Do not discard the acid. If you accidentally get acid or urine from the bottle on your skin or clothing, rinse the effected area immediately with plenty of cold water. Collection bottles must be refrigerated. This is best accomplished by using an ice chest, cooler, or if so inclined, your refrigerator.

If you forget to collect all of the urine or perform the test improperly, discard the specimen and start again on another day. If the bottle contained an acid preservative, you will need to obtain a new bottle from the laboratory or your physician's office. Otherwise, you may reuse the bottle after rinsing it with distilled water.

Finally, please remember to call your physician, medical provider or nurse if you have any questions about the proper collection of a 24-hour urine sample.

Adapted from: http://www.pituitarycenter.com/html/article2.html

This Topic on the Message Boards.


bullet

Urine Free Cortisol:

The standard Cushing's test. Helps confirm the diagnosis of Cushing's syndrome. All that the patient needs to do is to proceed with the Twenty-four Hour Urine.

bulletWhat "high" or "increased" may indicate: bulletWhat "low" or "decreased" may indicate:
  • Low levels have no diagnostic significance and do not necessarily indicate abnormally low adrenocortical function.
bulletTaking these drugs may affect test results:
  • Amphatamines
  • Morphine
  • Phenothiazines
  • Prolonged steroids
  • Reserpine
bulletOther factors that may affect test results:
  • Physical exercise
  • Stress
  • Failure to collect all urine during the test period
  • Failure to store the specimen properly

bulletUrine Potassium: Helps confirm the diagnosis of Cushing's syndrome as well as other disorders. All that the patient needs to do is to proceed with the Twenty-four Hour Urine.
bulletWhat "high" or "increased" may indicate:
  • Aldosteronism
  • Kidney failure
  • Dehydration
  • Starvation
  • Cushing's syndrome
  • Salicylate intoxication
What "low" or "decreased" may indicate:
  • Gastrointestinal disorder, such as malabsorption syndrome
bulletTaking these drugs may affect test results:
  • Acetazolzmide
  • Ammonium chloride
  • Thiazide diuretics
bulletOther factors that may affect test results:
  • Too much dietary potassium
  • Excessive vomiting or stomach suctioning
  • Failure to collect all urine during the test period
  • Failure to store the specimen properly

bulletUrine 17-Hydroxycorticosteroids(17-OHCS): Assesses adrenal-gland function. All that the patient needs to do is to proceed with the Twenty-four Hour Urine.
bulletWhat "high" or "increased" may indicate: bulletWhat "low" or "decreased" may indicate: bulletTaking these drugs may affect test results:
  • Acetazolamide
  • Chloral hydrate
  • Chlordiazepoxide
  • Chlorpromazine
  • Colchicine
  • Erythromycin
  • Estrogens
  • Etryptamine
  • Meprobamate
  • Oleandomycin
  • Oral contraceptives
  • Paraldehyde
  • Quinidine
  • Quinine
  • Reserpine
  • Spironolactone
bulletOther factors that may affect test results:
  • Failure to collect all urine during the test period
  • Failure to store the specimen properly

bulletUrine 17-Ketogenic Steroids (17-KGS): Evaluates adrenal-gland function. Helps confirm the diagnosis of Cushing's syndrome and Addison's disease. All that the patient needs to do is to proceed with the Twenty-four Hour Urine.
bulletWhat "high" or "increased" may indicate: bulletWhat "low" or "decreased" may indicate: bulletTaking these drugs may affect test results:
  • Cortiscosteroid therapy
  • Dexamethosone
  • Estrogens
  • Hydralazine
  • Meprobamate
  • Oleandomycin
  • Penicillin
  • Phenothiazines
  • Quinine
  • Reserpine
  • Spironolactone
  • Thiazides
bulletOther factors that may affect test results:
  • Exercise
  • Stress
  • Failure to collect all urine during the test period
  • Failure to store the specimen properly.